The information about the epidemic should in no way be hidden.
Aliaksandr Hluhouski, a doctor of Belarusian origin from the German city of Dortmund, tells what measures are being taken in Germany against the coronavirus pandemic, and compares them with what is happening in Belarus, Radio Svaboda reports.
- How did the German authorities react to the pandemic? Was the German health system prepared for this challenge?
- It is clear that chronic and urgent problems are inherent in any complex system. However, the organization and infrastructure, technical facilities, financing, and public accessibility are wonderful compared to most other countries.
How prepared can you be for such a situation? Even one of the world profile centers - the Robert Koch Institute in Berlin - recently admitted that until mid-February they did not expect the development of such a dramatic scenario in Europe, and the world.
Although even to me, not an epidemiologist, after China confirmed in early January the transmission of the virus between people, and the rapid spread of the epidemic in the second half of January with the first cases in the periphery, it became clear that pandemic could not be avoided.
There is nothing strange in my accurate forecast. The complexity of collective decision-making often determines the inertia and backwardness of a situation.
But even despite this lag, Germany’s powerful healthcare potential was at its peak and is now more or less successfully preparing for possible epidemic scenarios. There are expert groups of the main ministries and specialists - doctors, managers, economists, financiers and logistics. The Federal Crisis Headquarters operates almost 24 hours a day.
In the country, taking into account the experience and mistakes of the neighboring states, constant monitoring of the situation and recommendations of scientists, the necessary quarantine measures are gradually taken, and social contacts are limited.
Reserves are being mobilized in hospitals, potential drugs and treatment methods are being tested in laboratories, and research centers are also operating. The main anti-epidemic regulations, decrees and recommendations are adopted at the federal level. Inside, they have freedom of action at the land level.
Hospitals are now trying to make room for intensive care and keep them for covid patients. The state pays 600 euros per day for every available place.
- What are the restrictive measures in the country?
- In North Rhine-Westphalia, where I live, as in all of Germany, strict quarantine wasimposed from March 22 to April 19 (and most likely longer):
Only discounters and small grocery stores, pharmacies, hospitals, city services and some enterprises that provide the necessary infrastructure work.
All catering establishments, cinemas, theaters, libraries, museums, fitness centers, beauty salons, hairdressers and the like are closed.
For several weeks, all educational and pre-school institutions have been closed.
It is forbidden to gather more than two people if they are not relatives or partners living together.
The distance between people should be at least one and a half meters.
Shopping is permitted at nearby stores.
You can play sports outside the house, but no more than two people together.
In the early days, this was often violated, so on March 25, fines were increased - from 200 to 25,000 euros. People who gather in groups of more than 10 people can be prosecuted.
- What is the main difference between the health systems of Germany and Belarus?
- In Germany, the state finances major research centers and university clinics, which, in addition to treating patients, also conduct research. The remaining hospitals are private or controlled by religious charitable foundations of the main churches - the Catholic Caritas and the evangelical Diaconia.
There are no clinics, but there are private offices of general practitioners, family doctors and doctors of narrow specialties. Sometimes several of these doctors come together in a common room.
Virtually no doctor come to a patient’s home. Only in the case of a very difficult or threatening situation is an ambulance call justified. A state-subsidized system of private home care firms for critically ill patients or older adults with medical conditions is common practice.
- And even such a strong and well-organized healthcare system as in Germany, responded to the coronavirus too late, didn’t it?
- Since the authorities were guided by the recommendations of the Robert Koch Institute, then, as I already said, due to an inaccurate forecast of the pandemic, there was a delay. There were initially some wrong decisions.
This caused certain additional technical and organizational problems that are common to all countries. For example, lack of personal protective equipment, slowdowns with the beginning of quarantine.
One of the serious mistakes was the decision not to cancel the traditional annual Rhine Carnival in late February, which is attended by several million people in the western region. After the carnival, a major outbreak occurred in Germany.
The involuntary underestimation of the situation was also influenced by the successful and quick (without fatal outcomes) localization of the first episodic outbreak in Munich at the end of January.
- How does the coronavirus pandemic help those who do not have insurance (if any)?
- Any person who lives in Germany or comes to the country is required to have, for example, medical insurance. Therefore, there is no such problem.
- In Germany, is there a difference in approach to patients between private and public hospitals? Does property inequality, the level of patient income play a role?
- The basis of health care in Germany is the compulsory insurance of the entire population with the law guaranteed equal level, and accessibility of medical care.
High-income groups and government employees have the right to private insurance, which offers certain advantages - less time to wait for a consultation with high-level specialists, placement in a single ward, etc. But not in the amount of medical care.
There are no significant differences in the purely medical aspect between public and private hospitals and hospitals under the patronage of the Catholic and Evangelical churches.
- How do you see from Germany the situation with the coronavirus pandemic in Belarus? How late is the reaction? Is it too late to quarantine?
- The first thing that catches the eye is the lack of sufficient and timely information. Closed decision making. It is difficult to draw any conclusions if you do not know what forecasts and expert models the state leadership relied on, adopting a strategy of the practical absence of quarantine measures - both domestically and abroad.
Based on the epidemiological assumptions and taking into account the specifics of Belarus - the general density and distribution of the population, the demographic composition, as well as the characteristics of the SARS-CoV-2 virus - its high contagiousness, long asymptomatic incubation period and mortality rate, the strategy adopted in Belarus seems more than risky.
Let me remind you that I am not an epidemiologist and, therefore, not an expert in the full sense of the word. However, the lack of sufficient and accessible information justifying both measures taken and not taken, and the dramatic development of events in countries that lost time for severe quarantine restrictions, followed by the collapse of healthcare structures and high mortality rates, as well as a gradual forced change of tactics and tightening restrictions in the UK, USA and even Sweden, do not leave me enough optimism.
Relations with several colleagues in Belarus, their assessment of the situation and its dynamics are also of concern. Perhaps the stake is on infectious disease specialists and the sanitary-epidemiological service of Belarus, which works following the model of the USSR. Perhaps this is constructively and functionally effective now.
However, I repeat: given the characteristics of the virus and the diseases that it causes, I am not optimistic that the epidemic will remain under control.
Most likely, the Belarusian leadership provided for reserve scenarios developed by epidemiologists. But the question is, how effective are they? If even the one that is being applied now does not seem adequate to the problem.
Aliaksandr Hluhouski is a cardiologist. He was born in Minsk and since 2002 he has lived and worked in Germany. He is currently a physician at the BFD Voluntary Federal Medical Service in Dortmund.